Small Group Options
Bright Choices Benefits Marketplace at a Glance - 2016 REINVENTING YOUR BENEFITS Liazon’s Bright Choices® Benefits Exchange® gives you: • Significant choices for Medical, Dental, Vision, Life and Supplemental Health Insurance and Health Savings Accounts •
Advanced technology to help you learn about and enroll in your benefits online with the Bright Choices portal
•
Help to retain quality employees and save money by offering a comprehensive benefits program
•
More support than ever to handle administration and billing, facilitate employee enrollment, and answer employee questions about health insurance and other benefits Bright Choices Login: Username: Password:
exchange.liazon.com UCC + 1st Initial of First Name + 1st Initial of Last Name + last 4 digits of SSN Full Social Security Number (no spaces or dashes)
Questions? For Sales Inquiries, Contact Our Sales Team at 1‐888‐280‐3958
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[email protected] (Hours: 8:00am‐5:00pm)
This comparison has been prepared as a guide to assist you in evaluating the program. This is not a complete comparison or contract and in no way details all the benefits, limitations, or exclusions. Rates and terms are subject to change.
Platinum 100 (Replacing 104 & 105) EPO Copay Embedded
Gold 221 (Replacing 203) EPO Copay ‐ Embrace Health Embedded
SMALL GROUP OPTIONS
Gold 222 (Replacing 204)
Silver 320 (Replacing 302)
Silver 322 (Replacing 305)
Bronze 400 (NEW)
EPO Hybrid Embedded
HDEPO Qualified Aggregate
EPO Hybrid Embedded
HDEPO Non‐Qualified Embedded
Bronze 421 (Replacing 407)
HDEPO Qualified Aggregate HDEPO Qualified Aggregate
(2015 Plan Mapping: (2015 Plan Mapping: (2015 Plan Mapping: (2015 Plan Mapping: both Platinum plans moved into (2015 Plan Mapping: Gold 203 will map into this plan) Silver 302 will map into this plan) Silver 305 will map into this plan) this Platinum plan) Gold 204 will map into this plan)
Preventative Care
Bronze 422 (Replacing 409)
(2015 Plan Mapping: Bronze 407 will mapinto this plan)
(2015 Plan Mapping: Bronze 407 will mapinto this plan)
Qualified services are covered in full.
Physician / Specialist
$15 / $35
Deductible then $30/$50
$20 / $40
Deductible then $25/$40
$40 / $60
Deductible then 50%
Deductible then 0%
Deductible then 50%
Hospital Stay
$500
Deductible then $1000
Deductible then 20%
Deductible then $0
Deductible then 20%
Deductible then 50%
Deductible then 0%
Deductible then 50%
Outpatient Surgery
$100
Deductible then $100
Deductible then 20%
Deductible then $100
Deductible then 20%
Deductible then 50%
Deductible then 0%
Deductible then 50%
Emergency Room
$100
Deductible then $100
Deductible then 20%
Deductible then $50
Deductible then 20%
Deductible then 50%
Deductible then 0%
Deductible then 50%
$10 / $30 / $60
$10/$50/$80 NOT subject to deductible
$10/$50/$80 NOT subject to deductible
Deductible then $10/50%/50%
$10/50%/50% NOT subject to deductible
Deductible then $10/$35/$70
Deductible then $10/50%/50%
Deductible then 50%/50%/50%
Prescriptions Dependent Rider
Deductible
In‐Network Coinsurance
Out of Pocket Maximum
In Network: $0 Single $0 Family
In Network: $250 Single $500 Family
In Network: $600 Single $1200 Family
In Network: $1500 Single $3000 Family
In Network: $2000 Single $4000 Family
In Network: $3500 Single $7000 Family
In Network: $5250 Single $10500 Family
In Network: $4500 Single $9000 Family
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
N/A
N/A
20%
N/A
20%
50%
0%
50%
In Network: $2000 Single $4000 Family
In Network: $6850 Single $13700 Family
In Network: $5000 Single $10000 Family
In Network: $6550 Single $13100 Family
In Network: $6850 Single $13700 Family
In Network: $6850 Single $13700 Family
In Network: $6550 Single $13100 Family
In Network: $6550 Single $13100 Family
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
$824.03
$694.85
$677.62
$591.01
$561.29
$496.70
$491.68
$484.78
EE+Spouse
$1,648.06
$1,389.71
$1,355.24
$1,182.02
$1,122.57
$993.40
$983.36
$969.55
EE+Children
$1,456.02
$1,236.42
$1,207.12
$1,059.89
$1,009.36
$899.56
$891.03
$879.29
Family
$2,403.66
$2,035.50
$1,986.38
$1,739.55
$1,654.83
$1,470.77
$1,456.46
$1,436.78
Single
SMALL GROUP RATES
Up to age 26 on all plans regardless of student status; Domestic partner covered.
Please note‐‐‐ Employee+Children and Family Rates include the Mandatory Pediatric Dental Charge ‐ your actual rate may be less depending on the number of qualifying dependents. Please note ‐‐‐ Please check your doctors as these are all EPO plans. EPO ‐ National Network w/First Health & Magnacare. Doctors can be found on www.cdphp.org
GROUP OPTIONS
Platinum EPO
Platinum EPO
Platinum 1 Embedded
Platinum 4 Embedded
Gold EPO HSA Qualified Gold 2 HDHP
Gold PPO
Silver EPO
Gold PPO
Aggregate Ded Embedded OOP
In Network and Out of Network Benefits
Silver 7 Embedded
Preventative Care Physician / Specialist
Hospital Stay
Emergency Room
3 visits at $0 then $5 / $40
$40 / $60
$300
$500
Deductible then $5 / $15
Out of Nework: Deductible then 20% In Network: Deductible then $500
Deductible then $200
$100
$100
$250
$250
Deductible then $100
Deductible then $75
Deductible then $5/$15/$25
Prescriptions
$5/$30/$50
In Network: Deductible then $300 Out of Nework: Deductible then 20% In Network: Deductible then $300 Out of Nework: Deductible then $300
Bronze EPO
Bronze EPO HSA Qualified
Bronze EPO HSA Qualified
Bronze 1 Embedded
Bronze 3 HDHP Embedded
Bronze 6 HDHP Embedded
In Network: Deductible then 20%
Deductible then $500
Deductible then $0
Out of Nework: Deductible then 40% In Network: Deductible then 20%
Deductible then $35 / $80
Deductible then $30 / $50
Deductible then $0
Out of Nework: Deductible then 40%
Deductible then 50%
Deductible then 30%
Deductible then $0
In Network: Deductible then 20%
Deductible then $100
Deductible then $0
Deductible then $500
Deductible then $0
Out of Nework: Deductible then 40% In Network: Deductible then 20%
Deductible then $300
Deductible then $100
Deductible then $0
Deductible then $10/$40/$60 $10/$40/$60 (Preventative Drugs not subject to deductible)
Out of Nework: Deductible then 20% In Network: Deductible then $10/$40/$60 (Preventative drugs not subject to deductible)
Deductible then 50%
Deductible then $300
Deductible then $0
Deductible then $10/$40/$60
Deductible then $0/$0/$0
Out of Nework: N/A
*RX Deductible then $10/$40/50%
(RX Deductible ‐ Separate (Preventative Drugs not (Preventative Drugs not from Medical ‐ subject to deductible) subject to deductible) $200s/$400f)
Up to age 26 on all plans regardless of student status; Domestic partner covered. In Network: $1700 Single $3400 Family *AGGREGATE Out of Network: $4000 Single $8000 Family *AGGREGATE
In Network: $0 $0
In Network: $0 $0
In Network: $1400 Single $2800 Family *AGGREGATE
In Network: $500 Single $1000 Family
In Network: $2500 $5000
In Network: $3500 Single $7000 Family *AGGREGATE
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: $4000 Single $8000 Family
Out of Network: N/A
Out of Network: N/A
In Network: 0% Out of Network: N/A
In Network: 0% Out of Network: N/A
In Network: N/A Out of Network: N/A
In Network: 50% Out of Network: 20%
In Network: N/A Out of Network: N/A
In Network: N/A Out of Network: N/A
In Network: 20% Out of Network: 40%
In Network: $3000 Single $6000 Family
In Network: $1400 Single $2800 Family
In Network: $6350 Single $12700 Family *EMBEDDED
In Network: $6850 Single $13700 Family
In Network: $6600 Single $13200 Family
In Network: $5500 Single $11000 Family *EMBEDDED
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
Out of Network: $8000 Single $16000 Family
Out of Network: N/A
Out of Network: N/A
In Network: $6450 Single $12900 Family *EMBEDDED Out of Network: $8000 Single $16000 Family *AGGREGATE
Deductible
In Network: $3500 Single $7000 Family
In Network: $5400 $10800
In Network: $6450 Single $12900 Family
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
In Network: 50% Out of Network: N/A
In Network: 30% Out of Network: N/A
In Network: 0% Out of Network: N/A
In Network: $6850 Single $13700 Family
In Network: $6450 Single $12900 Family
In Network: $6450 Single $12900 Family
Out of Network: N/A
Out of Network: N/A
Out of Network: N/A
All MVP liberty Plans include up to $200, per subscriber, per calendar year, for completing health‐related activities. AND each plan includes a $125 reimbursement, per subscriber, per calendar year, for kids sports, weight management and gym membership. That's $325!
WellLife Rewards SMALL GROUP RATES
Aggregate Ded Embedded OOP
Deductible then $0
In Network: $10/$40/$60
$5/$45/$90
Dependent Rider
Out of Pocket Maximum
Aggregate Ded Embedded OOP
$25 / Deductible then $40
(Preventative Drugs not Out of Nework: N/A subject to deductible)
Coinsurance
Silver PPO HSA Qualified Silver PPO HDHP
Qualified services are covered in full. In Network: $40/$60
Out of Nework: Deductible then 20%
Outpatient Surgery
Silver EPO HSA Qualified Silver 8 HDHP
$797.17
$788.01
$654.20
$706.70
$589.46
$531.61
$587.36
$486.26
$465.80
$444.74
EE+Spouse
$1,594.34
$1,576.02
$1,308.40
$1,413.40
$1,178.92
$1,063.22
$1,174.72
$972.52
$931.60
$889.48
EE+Children
$1,390.13
$1,374.56
$1,147.08
$1,236.33
$1,037.02
$938.68
$1,033.45
$861.58
$826.80
$791.00
Family
$2,306.87 $2,280.77 $1,899.41 $2,049.04 $1,714.90 $1,550.03 $1,708.92 $1,420.78 Please note‐‐‐ Employee+Children and Family Rates include Mandatory Pediatric Dental Charge ‐ your actual rate may be less depending on the number of qualifying dependents. Please note ‐‐‐ Please check your doctors as all plans have EPO Network (unless otherwise noted as a PPO). Doctors can be searched on www.mvphealthcare.com
$1,362.47
$1,302.45
Single
THE DIFFERENCE BETWEEN AN AGGREGATE PLAN AND AN EMBEDDED PLAN. AGGREGATE: For any policy with two or more members, the deductible and/or out‐of‐pocket maximum (OOPM) must be met by any one or any combination of members before the plan will make payments. EMBEDDED: Each member must meet their individual deductible and/or OOPM before the plan will make any payments. The individual deductible and/or OOPM also applies to the family deductible and/or OOPM level. Once the family deductible and/or OOPM has been met, the plan will begin payment of services for all members on the contract
HEALTH SAVINGS ACCOUNT (HSA)
Account Setup and Fees
No account setup fees through this program, only for Chamber Members. $3.95 monthly maintenance fee per account. Single: $3,350 Family: $6,750 Catch‐up: An additional $1,000 per year (if you're age 55 or older)
Maximum Pretax Contributions
Account earns interest tax‐free and balances roll over for future years
Balances
DENTAL INSURANCE In‐Network Value
Basic
Enhanced
Value
Basic
Enhanced
100% 80% 0%
100% 80% 50%
100% 90% 60%
80% 50% 0%
90% 70% 25%
100% 80% 50%
0%
0%
50% (Lifetime Max: $1,000/person)
0%
0%
50% (Lifetime Max: 1,000/person)
Preventive Basic Major Orthodontia Deductible
+ Spouse
Rates Monthly
+ Child(ren) Family
$50/person ($150 family maximum; Applies to Basic and Major Treatment only.)
$0
Calendar Year Max Employee
Out‐of‐Network
$750
$1,000
$1,500
$20.27 $42.89 $48.04 $71.48
$36.55 $66.33 $78.40 $112.93
$53.77 $106.17 $118.94 $183.38
Please see detailed summaries for out of network benefits
$500
$750
$1,000
Please visit exchange.liazon.com for more plan details. Included for each plan is a list of imitations and exclusions that pertain to your Dental Insurance coverage. Rates subject to change
Option 1 M100D‐20/20
Option 2 M130D‐10/25
VISION INSURANCE
Option 3 M130A‐10/25
Option 4 M150D‐5/10
Eye Examination
Comprehensive exam of visual functions and prescription of corrective eyewear
1 per year ~ $20 Copay in network
1 per year ~ $10 Copay in network
1 per year ~ $10 Copay 1 per year ~ $5 Copay in in network network
Lenses
Standard corrective lenses: single, bifocal, trifocal, lenticular
1 per year ~ $20 Copay in network
1 per year ~ $25 Copay in network
1 per year ~ $25 Copay 1 per year ~ $10 Copay in network in network
Frames
20% off the additional amount when patients choose a frame that exceeds the allowance. Available from all in‐network providers, except Costco locations.
Contacts
Copays listed for necessary lenses. Other copays apply for elective lenses and fittings
Rates Monthly
1 per 2 years 1 per 2 years 1 per year 1 per year $25 Copay in $20 Copay in network: $25 Copay in network: $10 Copay in network: network: up to $130 up to $100 allowance up to $130 allowance up to $150 allowance allowance 1 per year ~ $20 Copay in network
1 per year ~ $25 Copay in network
1 per year ~ $25 Copay 1 per year ~ $10 Copay in network in network
Employee
$6.90
$7.83
$8.71
$10.23
Employee+Spouse
$13.82
$15.69
$17.46
$20.51
Employee+Child(ren)
$11.68
$13.26
$14.76
$17.33
Family
$19.28
$21.89
$24.36
$28.61
LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT Employee
Partner
Child(ren)
Benefit Amount
Up to $300,000 of coverage $100,000 guarantee issue for new groups only.
Up to $100,000 of coverage $20,000 guarantee issue for new groups only.
Up to $10,000
Increment
$25,000
$5,000
N/A
Rates Monthly
Varies by age and amount of coverage, Varies by age and amount of coverage, from $0.10 to $1.85 per $1,000 rom $0.10 to $1.85 per $1,000
Rate is $0.19 per $1,000, regardless of number of children
Rates shown above are monthly. Employee needs to complete a Statement of Health Form for amounts exceeding Guarantee Issue. Employee must elect self‐coverage to sign up for dependent coverage, which may not exceed 50% of employee coverage. Children to age 21 or 26 (if a student).
TELEMEDICINE PROGRAM
Benefits
Rates (Monthly)
Consult A Doctor connects you to licensed physicians 24 hours a day, 7 days a week. Physicians can be contacted either via telephone (Tele‐Consults) or secure e‐mail (E‐Consults), and Consult A Doctor offers an informative, interactive, educational online Personal Health Manager. Services include: • Unlimited Tele‐Consults and E‐Consults and complete access to the Personal Health Manager • Low cost ($34.95–$39.95) comprehensive Medical Tele‐Consults, where prescriptions can be prescribed
$5.00 Per Month
Healthy Start
Benefits
Rates (Monthly)
Annual Maximum Per Incident Deductible
Additional Features
Rates (Monthly)
Healthy Coach
PHD Network: The Personal Health Development (PHD) Network gives you your own personalized online environment where you have the ability to uncover and learn about your individual health risks, such as Heart Disease, Diabetes, Stroke, and Stress. Based on your results, the system provides you with an individualized wellness program.
HEALTH AND WELLNESS PROGRAM Healthy Directions
PHD Network, plus Health Coach: The PHD Network is coupled with your own personal health coach: a registered nurse highly trained in behavior modification science. This skilled professional works with you regularly and is able to explain risks, uncover barriers to change that you may possess, and provide valuable health planning assistance.
$8.33 Per Month
$24.99 Per Month
Standard Plan $9,000
Superior Plan $14,000
$50
$50
PHD Network and Health Coach + Home Screening Kit: A home test kit helps you get an accurate snapshot of your most important lab values, such as cholesterol and glucose. The PHD Network and your coach explain your results and develop a plan for you. This plan gives you the tools to help you become healthier and avoid additional health care costs.
$41.66 Per Month
PET INSURANCE Avian & Exotic Pet Plan $7,000 $50
∙ Covers a multitude of medical problems and conditions related to accidents and illnesses—including office visits, prescriptions, tests, hospitalizations, and surgeries—for dogs, cats, birds, ferrets, reptiles, and other exotic pets. ∙ No pre‐authorization; Visit any licensed veterinarian worldwide. ∙ Optional Pet WellCare Protection™ Coverage is available to help dog and cat owners with the cost of routine care—including annual exams, vaccinations, and other routine care—with no deductibles. Based on age and species. Rates are discounted for Liazon consumers.
